Can’t the BMA just admit it doesn’t want pregnant women to have fun?

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Earlier this month, a review published by the Cochrane Library criticised the idea of ‘eating for two’ while pregnant, suggesting that doing so would affect foetal development and increase the likelihood of obesity in the child. At the weekend, the British Medical Association said it plans to revise all previous advice given to pregnant women, and will now inform them that the consumption of any alcohol while pregnant will have a negative effect on the child.

Why doesn’t the BMA just come out and say that it doesn’t want pregnant women to have any fun? The continual revision of medical advice to make it fit with our health-obsessed culture is impacting on all our lives, through smoking bans, drinking limits and calorie warnings on eclairs. But no one is monitored as much as pregnant women. Most expecting mothers want to do what is best for their child. Yet from the moment of conception, women embark on an interminable battle with their doctors and midwives, magazines, health books and the state, and must surrender their bodies to the ongoing scrutiny of our wellbeing-obsessed culture.

Any woman who is hoping to have a child will undoubtedly be concerned about the process of pregnancy. And it is ludicrous to think that women would go through nine months of sickness, backache and eventual incapacitation just to harm their baby before it is even born. Yet the fearmongering around pregnancy, and the attempt to control what women eat, drink and do while expecting, has gone largely unchallenged. The disgust at seeing a pregnant woman in a pub or smoking a cigarette is shared by all ages – everyone seems to think they know better than the pregnant woman herself what is in her best interests.

There are certain things that have been proved by science to have a detrimental affect on foetal development: chain-smoking and serious alcoholism or drug abuse will inevitably affect a pregnancy as much as they will the woman indulging in such activities. But increasingly, all sorts of non-harmful, occasional activities are being lumped in with such dangerous behaviour under the banner ‘harmful to the fetus’.

This extends to all aspects of a woman’s reproductive process. It’s easy to assume that abortion is free and legal in this country, but in order to get one a woman has to ask the permission of two doctors and prove that a pregnancy would cause considerable harm to her mental or physical wellbeing, rather than simply deciding she doesn’t want to be pregnant. The British Pregnancy Advisory Service has criticised the current process that women have to go through to get the morning-after pill. The pill costs £34.95 in some pharmacies. And the woman has to endure a medical consultation before she is given it. That is essentially a conversation about bringing on a period, as the morning-after pill is only effective up to 120 hours after sex.

Where is the uproar? There are no pregnancy walks or Twitter hashtags supporting women having a glass of wine when they like. We should be arguing for scientific sense to prevail so that women can decide for themselves how they should behave, based on fact rather than feeling. Contemporary feminism doesn’t seem interested in women’s experiences, unless it’s something to do with sex, weight or eating on the tube. Never mind being able to wear a mini skirt or whether someone compliments your bum – the real threat to women’s autonomy comes when they’re potential child-bearers. The lack of control pregnant women have over their own bodies is too often ignored by prominent feminist campaigners.

Women still do not have full reproductive rights. The removal of women’s autonomy once pregnant treats them as baby-making machines, in need of proper servicing, but second to the end product. Those who truly believe in women’s liberty should resist these very real impositions on our freedom and leave behind all the preoccupation with clothes, weight loss and wolf whistles.

So drinking alcohol in pregnancy is “fun” and anyone wanting to keep pregnant women and the unborn safe from the side effects is a killjoy? Advising pregnant women not to drink is now an “imposition on their freedom”. Wonderful.

Madeleine

I think the author means in moderation and is certainly not advocating binge drinking on a regular basis, with my three pregnancies about a 100 years ago I would mostly drink non-alcoholic beer because I got fed up with the alternatives (lemonade, coke, orange juice etc) but I did have the occassional, once or twice a month what I called my psychological G&T which consisted of ice,slice of lime, ONE capful of gin and filled up with tonic, now that was ‘fun’ and didn’t do any of my three unborn any harm at all; as in all things a sense of perspective is key; if any self-righteous know it all had taken it upon themselves to lecture me , I would have been furious.

Tarek

Until the safe dose is established, there is no such thing as moderation. Why the concept of not drinking at all for the duration of pregnancy is so offensive I don’t understand, simply because it’s my experience that 99% of pregnant women voluntarily eschew drinking. The other 1% comprises a group of women, some of whom need support not to drink as otherwise they may drink to excess. I do believe though that people need to be informed and that there should be no element of coercion of any kind.

Madeleine

When you say informed, do you mean ‘told’? I disagree with your percentage of 99% of women not drinking at all by the way, my experience of pregnant women who stopped altogether, was a lower percentage than yours, but then I’m going back to the 80s , and for goodness sake how many were alcohol free at the time of conception and until the time the pregnancy test showed a positive result? Unless you demand total abstinence for all fertile females I don’t know how else you are going to ensure that no unborn child will be damaged by it, maybe it’s better to accept that you cannot have control over how pregant women chose to live their lives, as you point out and we both know most are sensible and I’m sorry but I include women who have the odd glass of wine in that category too. Anyway, I don’t want to get into a protracted discussion so let’s just agree to disagree on our respective attitudes to how pregnant women should live their lives!

Tarek

My percentage is based on the 2000+ women whose clinical care I was either involved in directly or indirectly, not on immediate acquaintances.

Peem Birrell

I don’t believe you – where are the records of these 2000 women, only 20 of whom drank during pregnancy according to you?

Oh, and of these 20 women, of whom you say ‘The other 1% comprises a group of women, some of whom need support not to drink as otherwise they may drink to excess’ – what percentage of them might drink to excess? Quite a high standard error on that one, eh doc?

Why on earth do we waste time with clinical observations and research involving thousands of patients, lab studies and epidemiological modelling and analysis when apparently personal anecdote involving a few women over 25 years ago is so much more reliable I wonder?

nisakiman

Almost everything that comes out of the neo-puritan ‘Public Health’ lobby is hyperbolic tripe. The author is absolutely correct – drinking and smoking in moderation while pregnant will have absolutely no detrimental effect on the foetus, and in fact it is well known (although they will never publicise the fact, for fear it will send the ‘wrong message’) that women who smoke during pregnancy are far less likely to suffer preeclampsia, which is a real danger to both mother and child, unlike the smoking itself.

You’ve been thoroughly indoctrinated by the social engineers, Tarek. It’s time you did a bit of independent research. Just because it’s in the papers and on the BBC doesn’t mean it’s true, you know. In fact, that’s good reason to be sceptical, these days. We are surrounded by hordes of single-issue zealots and ‘health professionals’ (the current euphemism for eugenicists) who wish to control our lives and mould us into what their ideology would like us to be.

I have four children, all now adults, by two women. The mothers both smoked and drank alcohol during the pregnancy. Not to excess, just normally. All four children were born naturally, and were healthy and average weight, and they have all grown up to be healthy and intelligent adults. As have their peers, very many of whom were also born to mothers who smoked and drank during their pregnancy.

The medical profession seem to delight in scaremongering these days – they have developed a grossly over-inflated sense of importance. But they are not Gods; they are as fallible as everyone else. And they are also subjected to politically correct indoctrination in medical school, which they then parrot when they go into practice.

Take a step back and view objectively some of the claims that are trotted out about smoking and drinking, and if you have an iota of commonsense running through your veins, you will see them for the hysterical hyperbole that they are.

Tarek

It is my experience that reference to personal anecdotes, generalisation and resort to invidiousness is merely a poor cover for an abject ignorance of the facts. Science thankfully is not about “feelings” and “Well I did this and nothing happened”. It is about rigor and the facts, however unpalatable they may be, and the application of those facts to the greatest number for the greatest benefit. Admittedly at times politics plays a part in which facts are publicised but thankfully that is the exception as opposed to the norm.

Your claim re: preeclampsia is incomplete. Smoking decreases the risk of preeclampsia BUT increases the risk that should preeclampsia occur that it will be of the more severe type which costs women their health and often their lives, not to mention the lives of their babies even if managed optimally. Furthermore smoking in pregnancy increases the risk of miscarriage of a chromosomally-normal baby, intrauterine growth restriction which is a direct cause of stillbirth and by itself increases the risk of traumatic delivery, birth asphyxia, biochemical abnormalities of the newborn and admissions to the NICU. In addition, it is a risk factor for abruptio placenta in which the placenta shears off the uterine wall, causing a catastrophic haemorrhage than can kill the baby and occasionally the mother, if not necessitating an emergency hysterectomy and multiple blood transfusions and ICU stay. Smoking is a risk factor for premature rupture of membranes, a direct cause of preterm labour, the number 1 cause of perinatal death and disability due to prematurity. The list of deleterious effects of smoking goes on, so how anyone can justify it during pregnancy is beyond me.

Women who smoke suffer more complications in the form of lung infections, issues with intubation, have an increased risk of wound infection and have higher oxygen requirements; anyone of these can and have harmed women, sometimes mortally.

With regards alcohol, we know that it is a teratogen and causes fetal alcohol syndrome, a syndrome identifiable in up to 5% of the population, responsible for mental retardation, craniofacial anomalies and which costs the system millions of pounds a year per patient. A number of reports have made it clear that it does not always occur at a specific dose of alcohol and hence one cannot always point the figure at a “safe level”.

To dismiss the millions of babies harmed as a result of irresponsibility as “hysterical hyperbole” is frankly breathtaking. You dodged a bullet on multiple occasions; I congratulate you, but luck is not the basis of public health policy or advice.

I have seen up close, not on some YouTube video or via the witterings of people who think that a quick Google search gives them an opinion as valid or as informed as a medical professional who spends years training and taking care of patients ( it doesn’t, even if they fantasise that it does), the effects of smoking and drinking on the unborn and wouldn’t wish it on ANYONE.

Medical school is not about parroting PC-blessed facts; I fear you confuse it with Gender Studies/Media studies. Admittedly there are times when “facts” particularly those relating to cholesterol have been obtained as a result of “guidance” from the pharmeutical industry but that has nothing to do with PC. Your comments on fallibility, and that some members of the profession have a touch too much self-importance are spot-on.

Health professions as eugenicists? I don’t think so.

As for believing anything in the lay press, I certainly don’t. Most reporters on medical matters are as ignorant of basic science let alone medicine as I am of Chinese grammar, yet still feel qualified to write articles that mislead.

Thankfully, I have over 14 years of medical training to fall back on, not to mention experience, but I suppose that merely renders anything I have to say as beneath contempt.

Peem Birrell

>>fetal alcohol syndrome, a syndrome identifiable in up to 5% of the population
That statistic is certainly beneath contempt. If you believe it it doesn’t say much for your critical appraisal skills.

Tarek

The key words: “up to”. Furthermore given the sheer heterogeneity of the condition, there is a wide spectrum of manifestations hence rendering a clear and single number meaningless and impossible to state, hence the extrapolation from data by the CDC, but perhaps you think their skills are ” beneath contempt”

And if a clear and single number is meaningless then so is an ‘up to 5%’.

BTW I thought the whole point of EBM was to render appeal to authority (e.g. in your case CDC) subordinate to appraisal of evidence.

Tarek

The whole point of EBM is to integrate ” patient values, clinical experience and the latest evidence” per Dr. David Sackett. EBM was not designed to supersede clinical experts or to render obsolete the activities of recognised expert bodies / organisations, but to allow all access to a framework where the 3 components are respected as equal, but also to allow the establishment of clinical guidelines etc. There are also times where the literature is deficient e.g. rare diseases where we still need clinical experts to guide us based on their experience.

All clinicians are supposedly able to appraise the literature ( not true unfortunately) but ultimately in order to propagate knowledge and establish epidemiological norms per incidence / prevalence/ trends etc so called ” background knowledge” we do need expert groups who have the time and opportunity to trawl through the literature so that as a profession we can establish a body of knowledge we agree upon from which we can then move forward, hence my reference to the CDC

Frederick Robinson

Can’t Spectator (Health) admit that what they’re interested in is selling copies of their magazine?